Research is showing us that the severity of a pain problem, even including levels of physical disability, can be influenced by traumatic events from earlier in life without us even knowing it. In fact, studies on this subject have found that the presence of past trauma was associated with a two-fold to three-fold increase in the subsequent development of chronic widespread pain, and reports of abuse in childhood were associated with as much as a 97% increase in risk for chronic pain in adulthood. The risk goes up not just with abuse, but connections have also been found with other adverse childhood events including hospitalizations, family financial crises, and the death of a parent.

The connection between past trauma and present pain has to do with the way our brains respond to trauma. Trauma, whether physical or emotional, triggers a fight or flight response, where our physiological systems go through a series of whole-sale changes very quickly, designed to help us either ward off or escape from danger. Trauma experts refer to this as a state of hyper-arousal.

Once the trauma is over, the nervous system may start to calm down, ending its state of hyper-arousal, but the scars of this reaction can remain, sometimes embedded deep within the nervous system or smoldering just under the surface. In other words, our hyper-arousal response may go dormant, but the brain retains the ability to release it later in life, especially when confronted by a new challenge. Perhaps the most recognizable example of the effects of past trauma is seen through our military veterans who develop post-traumatic stress disorder from combat exposure, but a trauma history can also be the byproduct of adverse childhood events such as episodes of emotional, physical, or sexual abuse.

Our stored trauma memory can impact a pain experience that may occur many years or even decades later. So, a totally separate event later in life, like falling off a ladder or a simple ankle sprain, can trigger the release of a previously stored physiological and emotional trauma response. And this all happens without even consciously thinking about or remembering what caused the prior traumatic event. An outpouring of stress chemicals and messengers recreate that hyper-aroused state, making the pain even more intense and overwhelming because all we can focus on is the danger at hand, which is now the pain.

When treating a patient with chronic pain who is also experiencing active trauma symptoms, I have found that it is really hard to make progress on the pain management side of things if the trauma symptoms are not also actively treated. Sometimes the ship just can’t navigate where it needs to go until the storm quiets down. If you find yourself experiencing signs of hyper-arousal, such as anxiousness, panic attacks, irritability, and sleeplessness, be sure to make your physician aware of how you feel and seek guidance on options for treatment.

]]>https://peterabaci.com/2018/10/30/how-past-trauma-can-affect-how-you-experience-pain/feed/0Is Virtual Reality the Future of Pain Management?https://peterabaci.com/2018/10/30/is-virtual-reality-the-future-of-pain-management/
https://peterabaci.com/2018/10/30/is-virtual-reality-the-future-of-pain-management/#respondTue, 30 Oct 2018 18:06:12 +0000http://peterabaci.com/?p=841 […]]]>As scientists and physicians race to explore new and more effective strategies to treat pain, many are investigating how technology might play a role. One of the most exciting, and promising, developments in this area is the use of virtual reality.

The premise behind virtual reality is to create an artificial environment that the user can relate to and interact with in a meaningful way. The user’s activity, including movements of the eyes, head, and even the arms, modify the environment that the user is experiencing. Virtual reality can tap into a number of senses, including sight, sound, and even touch, making it a potentially valuable tool in treating medical conditions that impact the way the mind and the body interact.

One of the first uses of virtual reality for pain management was in distraction therapy. Distraction therapy works by diverting your attention away from something painful. The human brain’s ability to focus can become overwhelmed by pain; virtual reality technology can not only shift our attention away from the pain, but also keep it engaged away from the pain by creating emotional connections to the virtual experience. As an example, for somebody who likes chilling at the beach, using a virtual beach experience could be a great distraction choice.

While a lot of positive studies have now been published on the effectiveness of virtual reality and distraction therapy, most of its value appears to be in the management of acute pain episodes. For example, distraction therapy can help a patient go through a painful treatment with less pain while using less medication. Typically , though, distraction therapy only provides short-term windows of relief.

The big question now is whether virtual reality can play a meaningful role in the long-term management of a person’s chronic pain problem. In order for that to happen, virtual reality has to help the brain reshape itself in a way that changes the way it experiences pain. Some of my patients with complex chronic pain problems have been volunteering to help a local virtual reality company called CognifiSense gain clues on how virtual reality might be used to provide ongoing relief.

Using virtual reality, the patients create an avatar of their pain, where they create a visual representation of the pain in their body that they can see, hear, and start to manipulate. For somebody with a spine problem, the avatar may have a throbbing, pulsing, red image in the low back area, and if sciatica is also present, the user could see shooting orange-colored signals flash down a leg, as an example. All of this can have sounds created to produce an even more vivid representation of the pain. Once the user is able to connect with this virtual pain avatar, then through guided exercises they can start to change how they feel and think about their pain.

When virtual reality can effectively help create positive emotional changes, as well as lead to important cognitive shifts or thought processes that the user can carry over into their everyday life, then we start to see how impactful this type of treatment can actually become. Knowing how much pain can throw off our mood, communication patterns, attitudes, motivations, and behaviors, if virtual reality can indeed help lessen these effects, it could be a real game-changer.

]]>https://peterabaci.com/2018/10/30/is-virtual-reality-the-future-of-pain-management/feed/05 Ways to Manage Pain Flare-Upshttps://peterabaci.com/2018/10/30/5-ways-to-manage-pain-flare-ups/
https://peterabaci.com/2018/10/30/5-ways-to-manage-pain-flare-ups/#respondTue, 30 Oct 2018 17:59:25 +0000http://peterabaci.com/?p=838 […]]]>If you live with chronic pain, one of the most important things you can do for yourself is to learn how to manage pain flare-ups. A pain flare-up is a substantial increase in the intensity of an underlying chronic pain problem. While the change in pain level can be dramatic, it is not a new pain, but rather a significant exacerbation of a pain problem that already exists.

Still, the sudden spike in pain can be so unsettling that you may worry that there is a new injury or problem, leading you to shift your attention from calming the flare-up to seeking a new diagnosis and new treatment for this “new pain” (which isn’t really a new pain at all). All of this misplaced effort allows pain to run amok.

A pain flare-up is not to be confused with the term breakthrough pain, which originally came about to describe increases in cancer pain that were not adequately controlled by pain medications and needed an extra boost. Breakthrough pain eventually became a popular term for the pharmaceutical industry to promote the daily use of added pain painkillers during the day to try to bring down routine fluctuations in pain levels.

Pain flare-ups can be attributed to a whole host of causes, including these common culprits:

Physical Activity – A certain movement or task can set off a pain crisis. For example, something as simple as bending the wrong way or sitting too long in the car can be a trigger.

Stress – Whether it be emotional or physical stress, going into fight-or-flight mode seems to make us more sensitive to pain. We have a tendency to carry stress in our bodies right where we hurt the most.

Poor Sleep – Studies have shown that pain intensity can correlate with the quality of our sleep. Something as simple as staying up an extra hour later than normal can leave you feeling more pain sensitive and uncomfortable the next day.

Overdoing It – Trying to get too many things done in a day or participating in an activity for longer than what you can typically handle is a common cause of flare-ups.

Eating the wrong foods – Foods that cause inflammation, fluid retention, dehydration, or trigger headaches can play a role in aggravating an existing pain problem.

A Virus – Having the flu or a cold can leave muscles and joints feeling achy and can easily make a chronic pain problem feel that much worse.

??? – It is worth pointing out that sometimes pain flare-ups occur from no particular cause; they just happen.

Whatever the trigger, it may be helpful to think of a flare-up as a situation where something has gone awry in the communication between the nervous system and the musculoskeletal system. The processing of information in the brain and the nerves that connect with your body are telling your muscles to react and tense up. Having a robust flare-up management game plan is an integral part to successfully managing chronic pain.

Pacing – Learning how to slow down and pace activities can be a critical part of living well with a chronic pain problem. If overdoing it causes you to crash for the next few days, then pacing will actually help you get more done in the long-run. Consider breaking up tasks into smaller jobs as opposed to trying to do them all at once.

Avoid Shutting Down – Sure, rest is an important part of recharging, but too much avoidance of activity can actually make the pain worse. Find the right balance between moving too much and aggravating the flare-up-up versus doing too little and causing the body to get tighter, stiffer, and sorer.

Don’t Panic – A bad pain flare-up can set off all kinds of alarms. But this mindset will only serve to make you tenser and hurt even more. Learn strategies to calm the nervous system and use them when you start to feel control slipping away.

Move – It may seem counter-intuitive, but the right movement strategies can be your best friend when it comes to managing a flare-up. Learn stretches to release tight muscles groups, or consider gentle yoga poses to connect the mind with the body in a calming way. And even doing some cardio or a nice walk can improve your mood and outlook enough to reduce the pain.

Pamper Yourself – This might be a good time to book a massage, check in with the chiropractor, or see an acupuncturist, if these practices have a proven track record with your particular condition. It helps to have an outside support team

Creating a successful flare-up-up tool kit will be well worth your time and energy, but it might mean thinking outside the box to get there.

]]>https://peterabaci.com/2018/10/30/5-ways-to-manage-pain-flare-ups/feed/0How to Let People In When You Have Chronic Painhttps://peterabaci.com/2018/06/16/how-to-let-people-in-when-you-have-chronic-pain/
https://peterabaci.com/2018/06/16/how-to-let-people-in-when-you-have-chronic-pain/#respondSat, 16 Jun 2018 23:59:12 +0000http://peterabaci.com/?p=722 […]]]>When someone is in pain, their whole family is impacted.

I was reminded of this truth recently as visitors approached my booth at the Los Angeles Times Festival of Books. I was struck by how many people were stopping by my booth on behalf of somebody in their lives who was having a difficult time with chronic pain. The most memorable was when a brother and sister, probably about 5 and 6 years old, dragged their mom over to talk to me about their grandfather, who was struggling with neck pain. At their young age, they shared powerful insights about their grandfather’s condition, not to mention a strong sense of wanting to help.

Though you might feel isolated in the midst of a pain experience, those around you are likely deeply impacted by what you are going through – and there’s a good chance that they really want to be with you in this experience. They may just not know how to get in.

Here are a few ways you can share your pain experience with people who care about you:

Education: The better others understand your health challenges, the more helpful they can be. I recommend you share some of the books or articles that you have found helpful, and consider inviting them to join you at some of your doctor visits or physical therapy sessions.

Recreation: To build better bonds, try to have some fun together. If there are activities, sports, or hobbies that you no longer do, now is the time to find new pursuits that you can share with others. Whether it is going on walks together or hosting a movie night, plan activities that are joyful for everyone. Try to use this as an opportunity for growth.

Communication: It is easy to feel closed-off from others and to not want to engage when you don’t feel well, but it’s important to make an effort to create dialogue between you and your family. If you feel a strong instinct toward isolation, you may need to create a deliberate plan to combat it – consider scheduling a specific time to chat. Of course, it’s reasonable to spend some of the time talking about your own challenges, but to truly connect with others, you’ll want to talk about things going on with other members of your circle as well.

Expression: Nonverbal communication plays an important role in how we connect with others, especially when we are in pain. Facial expressions and grimacing can say a lot without uttering a word, and how we say things, or the tone that we use, also influences how others receive our message. I am not recommending that you try to hide how you feel or present yourself in a way that is false, but it might be worth taking stock of your nonverbal communication patterns to see if any subtle changes might make it clearer to the people around you that you are open to connecting with them. Eye contact can boost connectivity during a conversation, and a smile can go a long way to letting someone know how much you appreciate them.

Hopefully, adding a few of these strategies can help open the door to connection, and possibly even strengthen your relationships.

]]>https://peterabaci.com/2018/06/16/how-to-let-people-in-when-you-have-chronic-pain/feed/0The Low Back Pain Treatments Your Doctor Isn’t Telling You Abouthttps://peterabaci.com/2018/06/16/the-low-back-pain-treatments-your-doctor-isnt-telling-you-about/
https://peterabaci.com/2018/06/16/the-low-back-pain-treatments-your-doctor-isnt-telling-you-about/#respondSat, 16 Jun 2018 23:56:41 +0000http://peterabaci.com/?p=718 […]]]>If you’ve been feeling like your doctor visits aren’t doing much to help your low back pain, there’s now some research to back you up. The health journal, TheLancet, recently published a series of articles looking at how we treat back pain, and the gist of their findings is that most of us who go to a doctor for an aching back are probably receiving inappropriate or unnecessary treatment. According to the researchers, the most common missteps by doctors include over-reliance on medications including opioids, pushing bedrest and avoidance of activity, emphasizing tests like x-rays and MRIs too quickly, and depending too much on invasive treatments like injections and surgeries. So, what should doctors be suggesting instead? The authors offer these evidence-based recommendations: more education about pain management, resuming of normal activities, exercise, and “psychological programs for those with persistent symptoms.” My guess is that this last recommendation – that we need more in the way of psychological treatments for low back pain – caught you by surprise.

Though back pain is a physical problem – there is tissue inflammation and irritation that needs to be treated – it’s actually better viewed as an experience, and one that can encompass a vast array of elements including emotional and psychological factors. On any given day, the emotional reactions that are generated in connection to our pain, along with the thoughts, attitudes, and judgements that arise, all contribute in important ways to our low back pain experience.

The way bodily pain gets processed in our brains is strongly linked to the same circuits that handle thoughts and feelings. For example, the onset of low back pain can trigger a stress cascade leading to feelings of fear, anxiety, worry, irritability, or depression. High levels of psychological distress, along with catastrophizing, where we can only see the worst in a situation, have been tied to a higher chance that pain will become ongoing. Ignoring these types of factors only leads to more suffering and poor outcomes.

So, what can be done psychologically to help improve the situation?

Anything that can help improve your outlook and diffuse an over-agitated nervous system can be helpful, but there are some specific psychological approaches worth looking into:

Pain Psychology – Several sessions with a psychologist or therapist who specializes in pain management can help you learn useful tools and strategies. Cognitive-behavioral therapy is a well-established form of psychotherapy that focuses on reprocessing dysfunctional thought patterns to decrease emotional distress. Another promising psychological approach used in the treatment of pain is Acceptance and Commitment Therapy (ACT) which promotes improving psychological flexibility as a way of overcoming health challenges.

Mindfulness – Mindfulness works on activating brain relaxation pathways as a tool to relieve pain and reduce stress and anxiety. Some studies have shown that practicing mindfulness can improve pain and well-being for patients with conditions like chronic low back pain. Mindfulness-based stress reduction (MBSR) is a structured 8-week program geared to teach useful mindfulness-based techniques, and these courses can now be found in many communities.

Progressive Muscle Relaxation – Muscles that surround and support the spine and pelvis often tense up as a protective mechanism after a back injury, but when that tensing continues and doesn’t let up, it can lead to more pain and problems with mobility. Learning tools and techniques to relax these over-activated muscle groups can reduce discomfort and improve function.

Multidisciplinary Programs – Combining psychological treatments and education with exercise and movement can be an effective way to treat challenging back problems. In my own practice, we offer something known as a functional restoration program which is a structured 6-week, 6-hour/day program that combines psychology classes with exercise and other modalities. A more comprehensive approach has the advantage of working on all aspects of the pain experience in a coordinated way.

Unfortunately, in many communities these types of recommended treatments are often not available or not covered by insurance. If you are having trouble finding local resources, consider looking into telemedicine for an on-line therapist or check out apps geared toward relaxation training and meditation. And don’t forget that emotional well-being can get a boost in many other ways including exercise, social bonding, listening to music, yoga, tai chi, and just getting more fresh air.

]]>https://peterabaci.com/2018/06/16/the-low-back-pain-treatments-your-doctor-isnt-telling-you-about/feed/0Conquer Your Brain – RSDSA of Americahttps://peterabaci.com/2018/05/09/conquer-your-brain-rsdsa-of-america/
https://peterabaci.com/2018/05/09/conquer-your-brain-rsdsa-of-america/#respondWed, 09 May 2018 16:01:30 +0000http://peterabaci.com/?p=714https://peterabaci.com/2018/05/09/conquer-your-brain-rsdsa-of-america/feed/0Getting off Opioids: 6 Tips From a Pain Experthttps://peterabaci.com/2018/04/17/getting-off-opioids-6-tips-from-a-pain-expert/
https://peterabaci.com/2018/04/17/getting-off-opioids-6-tips-from-a-pain-expert/#respondWed, 18 Apr 2018 04:38:42 +0000http://peterabaci.com/?p=711 […]]]>As pressure to cut back on prescription opioids continues to mount, doctors and patients are feeling the heat. If you have been on long-term opioid therapy and are now being asked to switch to a different pain management method, you may feel concerned and fearful about weaning off opioids.

To better understand why coming off opioids can be such a challenge, consider how our bodies handle opioids. We each have a naturally occurring internal opioid system that not only regulates pain, but also impacts our social interaction, cardiovascular health, metabolism, stress, learning, mood, respiration, digestion, immune function, sexual activity, and reward and addiction. In other words, just about everything that goes on in the body can be impacted by our internal opioid system to some degree. So, when we consider replacing our natural coping mechanisms for things like stress, social bonding, and reward-gratification with prescription painkillers, we start to get a sense of why pulling them away can be such a challenge. On top of dealing with concerns about how to manage the pain, there is also the struggle to regain equilibrium in managing basic life functions.

If you find yourself in a position of needing to reduce or wean off your prescription opioids, I recommend working with your doctors to put together a well-thought-out strategy for long-term success. Based on the latest research, some of my own experience, and the experience of other experts, here are some tips to help you and your physician work toward a successful medication transition:

Emotional support is a must: Weaning opioids is anxiety-provoking and stressful for almost everyone, so it is important to build your support structure before you start the process. A pain psychologist or counselor can help manage some of those fears and can also help you explore behavioral-based approaches for pain management. Stay connected with your support team throughout the weaning process and have regular scheduled appointments and meetings times already in place.

Slow and steady wins the race: I had a chance to catch up with Beth Darnall, PhD, a Stanford psychologist and leading pain researcher, to talk about her recently published study in JAMA Internal Medicine on ways to effectively wean opioids. She notes that patients do the best when they are not forced to wean too quickly, but rather approach it voluntarily and at their own pace. In other words, you can expect this to go more smoothly when you are a key part of the decision process. In fact, Dr. Darnall found that for the patients who hung in there, the pain did not get worse based on measurements of pain intensity and pain interference.

Consider MAT: MAT stands for medication-assisted treatment for opioid dependence, and it combines the use of medications, like buprenorphine, with behavioral therapy. Most experts agree that medication assistance works better for opioid detox than abstinence in cases of significant dependence. In my experience, buprenorphine can be an effective tool as part of a comprehensive treatment plan for the treatment of opioid-dependence coupled with chronic pain. Unfortunately, there is still a lot of pushback from insurance plans in covering medications like buprenorphine despite demand for greater access. Be prepared to be a squeaky wheel!

Find an acupuncturist: Many of my patients find acupuncture helpful when going through the medication transition process. It can help diminish withdrawal symptoms, quell anxiety, and reduce pain. Auricular acupuncture, which focuses on pressure points around the external ear, is often particularly helpful for detox and can be done easily and safely. Both the World Health Organization and the National Institute of Health have recommended acupuncture as an aid for detox treatment, although well-designed scientific studies to support this still seem to be lacking.

Have a vision: Most patients that I meet tell me that they don’t want to stay on their medications forever, but they just don’t know what else to do and are afraid to let go. This might be a good time to explore alternative treatments that will align you with the goals that you have for yourself. If you see yourself stuck in a rut but wanting to be more active, more engaged, and happier with life, now is the time to come up with a plan that can actually get you there.

Dive deeper: Going beyond painkillers is in some ways an opportunity to better understand both your body and your inner self to get to the root underlying causes of the pain. If you have been treating things like tight muscles, stiff joints, stress, and even panic attacks mostly with pills, then you probably haven’t fully addressed some of the core causes of why you hurt, and therefore have missed out on opportunities for recovery. Seek out behavioral health practitioners and movement experts who can help you make this not just a tapering process, but a true healing process!

Becoming an active part of the weaning process can help diminish your fear, anxiety and stress. As legendary basketball coach John Wooden once said, “Things turn out the best for the people who make the best of the way things turn out.”

]]>https://peterabaci.com/2018/04/17/getting-off-opioids-6-tips-from-a-pain-expert/feed/0Fibromyalgia: How to Create a Recipe for Relief Based on New Researchhttps://peterabaci.com/2018/04/17/fibromyalgia-how-to-create-a-recipe-for-relief-based-on-new-research/
https://peterabaci.com/2018/04/17/fibromyalgia-how-to-create-a-recipe-for-relief-based-on-new-research/#respondWed, 18 Apr 2018 04:31:47 +0000http://peterabaci.com/?p=709 […]]]>Invisible and misunderstood. If you have fibromyalgia, you’ve probably used these two words at some point to describe your condition. You look perfectly healthy despite feeling just the opposite. Your bloodwork, X-rays, and MRIs come out pretty normal – making it hard for doctors to find evidence that something’s wrong, even though nothing feels right.

And as if the muscle pain and tenderness, constant fatigue, poor sleep, and “fibro-fog” weren’t enough, you have to deal with feeling misunderstood. Friends, family, and co-workers can’t grasp what you are going through, or even that you are going through anything at all (“But you don’t seem sick”).

If you have had it with feeling invisible and misunderstood, help seems to be on the way thanks to emerging research that is creating a clearer picture of the science behind fibromyalgia. Studies consistently seem to indicate that what sits behind the never-ending muscle pain and tenderness is an over-sensitized central nervous system. Research is showing that the fibromyalgia brain quickly gets over-agitated by both painful stimuli as well as by non-painful stimulation. Imagine that the volume on your television is set too high but you can’t adjust it. Every time you try to turn it on, you get blasted by the loud noise, so you resign yourself to leaving the television off to spare your ears. Likewise, fibromyalgia sufferers struggle each day in trying to avoid setting off over-active pain networks inside their central nervous systems.

We see evidence of this imbalance when measuring chemicals in the fluid around the brain, where studies show a higher concentration of inflammatory mediators in fibromyalgia patients. Along with chemical differences, new research is also finding evidence of something called “hypersensitive brain networks” in fibromyalgia. This may explain why ordinary sensations like light, sound, or touch feels uncomfortable to those with fibromyalgia. The frequent surges seen with these brain networks may override parts of the brain involved with focus and concentration, making it hard to shift attention away from the pain. Studies suggest that when there’s increased electrical activity in these networks, a person’s pain intensifies.

So how do we use this information to better control the pain and other symptoms of fibromyalgia? How can we better manage an overly sensitive and revved up set of brain circuits that seem to make everything hurt?

The other day I had a chance to chat with Jenni Grover, who writes about living with chronic disease on her popular site ChronicBabe.com and in her new book Chronic Babe 101. Jenni has dealt with fibromyalgia for many years, and through hard work she has gotten to a place where she can function pretty well and enjoy a great life. When I asked her which treatments seemed to help the most, it became readily apparent that it wasn’t just one thing that made a difference, but rather a combination of complementary therapies working together.

Jenni’s doctors didn’t just give her new prescriptions and send her on her way, but rather they helped her explore all sorts of treatments that would ultimately lead her to a place of greater independence and function. In other words, to get the best results, you need a variety of ingredients, each ingredient adding a little bit of flavor to the dish. Here are some of the “ingredients” that have been successful for Jenni:

Pacing, especially using tools like the BreakTime app on my computer or alarms programmed on my phone

Crafting, like quilting, sewing, paper crafts, coloring books

Daily yoga/stretch routine

Actively nurturing friendships and a strong social circle

As you can see, Jenni employs a very comprehensive and diverse approach to finding relief and staying active. In theory, the goal is to reign in these over-sensitive pain networks, not rev them up. Too much of one thing, like over-doing it in the gym might make things worse, while a small dose of exercise coupled with a little meditation, some extra hydration, and just a little extra sleep can tip things in the direction toward better function with less flare-ups. And engaging in different activities that boost focus and concentration, like sewing or making mandalas, helps train the brain to shift attention away from the pain. By pacing herself and using each part of her program in moderation, she is able to stay stronger, more engaged, and more active, while keeping her pain in a box and minimizing the bad days. And when you can do all of that, your quality of life with a chronic disease shoots way up.

The more we learn about chronic conditions like fibromyalgia, the better we understand the need for having a coordinated, multi-pronged approach to gain control. And the less invisible and misunderstood we start to feel.

]]>https://peterabaci.com/2018/04/17/fibromyalgia-how-to-create-a-recipe-for-relief-based-on-new-research/feed/02 Mistakes That Can Make Your Pain Worsehttps://peterabaci.com/2018/04/17/2-mistakes-that-can-make-your-pain-worse/
https://peterabaci.com/2018/04/17/2-mistakes-that-can-make-your-pain-worse/#respondWed, 18 Apr 2018 04:27:21 +0000http://peterabaci.com/?p=707 […]]]>What if I told you that, besides being generally unpleasant (to put it mildly), pain can also be deceiving and misleading? Yes! Pain can play tricks with our heads and fill us with thoughts that can be harmful and hold us back from getting better.

Here are two of the most powerful mind tricks that pain plays on us (they may surprise you!):

Catastrophizing

Think of catastrophizing as a thought process where you see the worst in a situation and consider only the most negative of possible outcomes. Catastrophizing is often associated with rumination, meaning you keep thinking that something terrible is going to happen and you can’t get it out of your head. This constant negative thinking can then directly impact your feelings and emotions, which means you can start to freak out or get really depressed.

A lot of pain research done over the years suggests that catastrophizing can have a big impact on how we hurt. Not only does catastrophizing influence the intensity of our pain, but it seems to play a significant role in whether the pain becomes chronic or not. In fact, studies have found that catastrophizing can lead to an increased chance of long-term disability.

In some cases, how we interpret the words we hear from our doctors can determine how much we catastrophize. For example, if your physician tells you that you have really degenerated discs in your lower back, you could respond by ruminating that this a “terrible” problem that will never go away and will likely lead you down a path of becoming wheelchair dependent. Or, you could choose to interpret this as a common diagnosis that happens as we get older and decide you are going to do whatever you can to minimize its impact so you can continue to lead an active and happy life. Two different mindsets to the same problem can lead to very different outcomes.

But if you are the person hurting and you don’t have a medical background, how do you know if what you are thinking is reasonable or catastrophizing? This is might be a good topic to bring up with your doctor, especially since research shows that catastrophizing is usually overlooked by most doctors. If you find yourself feeling very worried about anything related to your health, why not let your physician know how you feel and get their perspective on how realistic your fears might be. There is a good chance that your doctor has treated similar situations to yours many times in the past.

If you find yourself ruminating excessively, ask your physician for assistance in learning tools for quieting these thoughts and finding ways you can see your health in a more positive light. Studies show that decreasing levels of catastrophic thinking actually lead to better pain treatment outcomes.

Associating Pain With Harm

Pain and injury don’t go hand in hand when it comes to chronic pain. Granted, pain is the hallmark sign of an acute injury like a broken bone, and the disappearance of that acute pain is a notable sign of tissue healing and repair. Starting in childhood, our brains learn to equate pain with harm or injury that we carry into adulthood and use as a protective mechanism. But this typical learned behavior can pose a problem for those working to overcome a condition that is more chronic.

When pain triggers this warning alarm, we go through a fight or flight response as a protective mechanism to either fight off or run from danger. But if we go through this type of fire drill every day, then we develop a dysfunctional behavior pattern where we keep our attention focused on a perceived threat that doesn’t really exist. This can leave us feeling agitated, anxious, and fearful, and prevents us from moving on with our day and engaging in otherwise meaningful activities.

Consider the example of neck pain from a whiplash injury. The pain you feel right after getting rear-ended is related to acute tissue inflammation, but feeling neck pain a whole year later is a different matter. When pain is felt with moving chronically tight and sore muscles or joints, that doesn’t mean injury is taking place. Rather, it is a sign that your body has learned to resist such movements and needs to go through a careful process to recondition and retrain certain muscles, tendons, joints, and nerves to behave differently.

But if you continue to avoid turning your neck for many months because of the negative feedback of the pain, then your neck will only get stiffer and hurt even more, and keep you from engaging in meaningful activities. Yes, pain can play wicked games on our minds and hold us back from getting better if we let it! Overcoming this tricky “pain – fear – avoidance” loop is not easy and may require assistance, but the first step is getting to a place where you understand the difference between experiencing pain versus doing something that is actually harmful or dangerous to your body.

With both catastrophizing and the misconception that chronic pain is a sign of further harm, we see ourselves misinterpreting our medical condition to the point of letting it disrupt our lives in very negative and lasting ways. Turning the tide on these two barriers to recovery might be just the thing that helps you find relief.

]]>https://peterabaci.com/2018/04/17/2-mistakes-that-can-make-your-pain-worse/feed/0How a Positive Attitude Can Improve Your Pain – and Your Lifehttps://peterabaci.com/2018/04/17/how-a-positive-attitude-can-improve-your-pain-and-your-life/
https://peterabaci.com/2018/04/17/how-a-positive-attitude-can-improve-your-pain-and-your-life/#respondWed, 18 Apr 2018 04:24:00 +0000http://peterabaci.com/?p=705 […]]]>I often hear my pain patients express regret about treatments they chose in the past (“I should have never had that surgery”) or remorse for the unhealthy lifestyle choices they’ve made, like smoking, avoiding exercise, or eating junk food. And sure, the treatment and lifestyle choices you made in the past do play a big part in determining your health – but so does the attitude you choose to have today. Your attitude can greatly impact how you respond to treatment, the way you are treated by others, and basically, whether or not you feel happy and fulfilled at the end of the day.

I see firsthand what differentiates successful patients from those who continue to struggle and suffer, and the one attitude or state of mind that always seems to correlate with positive outcomes is that of gratitude. That special quality of feeling grateful or thankful toward others or about life as a whole seems to carry with it unique healing powers. In fact, gratitude has been associated with a longer life, a better mood, and even a better immune system. In my clinic, those who smile the brightest are the ones who are the most grateful for what is positive in their lives despite their very challenging medical problems.

My patient Joe is a notable example of the power of gratitude and a positive attitude. He injured his neck while doing heavy-duty electrical work. By the time I first met Joe, he already had gone through neck surgery but unfortunately was not doing well, and to make matters worse he was fast approaching the deadline with his job. He would lose it if he did not return to full duty, and his job was very physical.

Joe had a family that was depending on him, and my team felt that we could provide a special intensive program for Joe that could help him turn things around and get back to work. But the only way to make the deadline was to start the treatment right away without waiting for the insurance approval (and running the risk of never getting paid for our efforts), so that is what we did, and Joe did not disappoint. He completed his program, made amazing progress, saw his pain diminish to low levels, and made it back to work before losing the job he loved. At the end of it, he gave me a thank you card that I will always cherish, including lottery tickets for “a chance at something great, which is exactly what you have given me.” Joe made sure he let everyone involved know how thankful he was for their help.

Before we started treatment, Joe let me know that he was not only anxious about his situation, but also angry that his surgeon wrote him off as “fixed” even though he was not feeling better or able to function at a level that he hoped to reach. Certainly, his worry and irritation about his situation could have gotten the best of him and even impacted his ability to recover, but Joe was able to contain these thoughts and keep them from taking over. Let’s take a look at some of the key thinking shifts that he made that helped fuel his success:

He kept hope alive – Fear is a powerful force, and when we are hurting and struggling, it can overwhelm us to the point that we freeze up and are unable to move forward. Joe was able to keep his fear in check by not losing hope while maintaining faith in his ability to work through his challenges. He stepped out of the fear box.

He let go of his anger – Joe pushed his anger aside by shifting his focus and energy toward getting healthier and learning tools that would help him manage the problems more effectively. He focused on the gains that could be ahead, as opposed to the disappointments of the past.

He created reasonable expectations – None of us can go back in time and have the body that we had before we got injured. It is much more helpful to work on being your best self in the present tense and let go of what was. In some cases, that might mean accepting certain limitations and accepting that you will not be pain-free.

He adopted the attitude of gratitude – Even before he started to improve, Joe repeatedly expressed gratitude about being given an opportunity for recovery, and that may have had a positive impact on his outcome. In the words of gratitude researcher Robert Emmons, PhD, “Gratitude heals, energizes, and transforms lives.

You probably never thought your attitude can make your pain go up or down, but in my experience, the right attitude can be a key ingredient toward finding relief.